Long-Term Care Facility Disaster Preparedness, June 19, 2014

Long-term care facilities have very difficult decisions to make in terms of evacuating residents/tenants or providing “shelter in place”. Long-term care facilities need to be actively involved with the Emergency Management Teams at the county level and work with them to develop effective disaster preparedness plans. When it comes to disaster preparedness it is important to write a plan, exercise the plan, revise the plan, re-exercise the plan and identify the best practices.

Potential of incorporating ocean currents in fishing vessels

The fishing sector has been suffering a strong setback, with reduction in fishing stocks and more recently with the reduction of the fishing fleet. One of the most important factors for this decrease, is related to the continuous difficulty to find fish with quality and quantity, allowing the sector work constantly all year long. However other factors are affecting negatively the fishing sector, in particular the huge maintenance costs of the ships and the high diary costs that are necessary for daily work of each vessel. One of the main costs associated with daily work, is the fuel consumption. As an example, one boat with 30 meters working around 17 hours every day, consumes 2500 liters of fuel/day. This value is very high taking into account the productivity of the sector. Supporting this premise was developed a project with the aim of reducing fuel consumption in fishing vessels. The project calls “ShipTrack” and aims the use of forecasts of ocean currents in the routes of the ships. The objective involves the use of ocean currents in favor, and avoiding ocean currents against, taking into account the course of the ship, in order to reduce fuel consumption and increase the ship speed. The methodology used underwent the creation of specific Software, in order to optimize routes, taking into account the forecasts of the ocean currents. These forecasts are performed using numerical modelling, methodology that become more and more important in all communities, because through the modeling, it can be analyzed, verified and predicted important phenomena to all the terrestrial ecosystem. The objective was the creation of Software, however its development was not completed, so it was necessary a new approach in order to verify the influence of the ocean currents in the navigation of the fishing ship "Cruz de Malta". In this new approach, and during the various ship routes it was gathering a constant information about the instant speed, instantaneous fuel consumption, the state of the ocean currents along the course of the ship, among other factors. After 4 sea travels and many routes analyzed, it was possible to verify the influence of the ocean currents in the Ship speed and in fuel consumption. For example, in many stages of the sea travels it was possible to verify an increase in speed in zones where the ocean currents are in favor to the ships movements. This incorporation of new data inside the fishing industry, was seen positively by his players, which encourages new developments in this industry.

Cartographie semi-automatisée des chutes de pierres le long d’infrastructures linéaires

La caractérisation détaillée de vastes territoires pose un défi de taille et est souvent limitée par les ressources disponibles et le temps. Les travaux de cette maîtrise s’incorporent au projet ParaChute qui porte sur le développement d’une Méthode québécoise d’Évaluation du Danger des Chutes de Pierres (MEDCP) le long d’infrastructures linéaires. Pour optimiser l’utilisation des ressources et du temps, une méthode partiellement automatisée facilitant la planification des travaux de terrain a été développée. Elle se base principalement sur la modélisation des trajectoires de chutes de pierres 3D pour mieux cibler les falaises naturelles potentiellement problématiques. Des outils d’automatisation ont été développés afin de permettre la réalisation des modélisations sur de vastes territoires. Les secteurs où l’infrastructure a le plus de potentiel d’être atteinte par d’éventuelles chutes de pierres sont identifiés à partir des portions de l’infrastructure les plus traversées par les trajectoires simulées. La méthode a été appliquée le long du chemin de fer de la compagnie ArcelorMittal Infrastructures Canada. Le secteur couvert par l’étude débute à une dizaine de kilomètres au nord de Port-Cartier (Québec) et s’étend sur 260 km jusqu’au nord des monts Groulx. La topographie obtenue de levés LiDAR aéroportés est utilisée afin de modéliser les trajectoires en 3D à l’aide du logiciel Rockyfor3D. Dans ce mémoire, une approche facilitant la caractérisation des chutes de pierres le long d’un tracé linéaire est présentée. Des études de trajectoires préliminaires sont réalisées avant les travaux sur le terrain. Les informations tirées de ces modélisations permettent de cibler les secteurs potentiellement problématiques et d’éliminer ceux qui ne sont pas susceptibles de générer des chutes de pierres avec le potentiel d’atteindre les éléments à risque le long de l’infrastructure linéaire.

Les échos de la "Comédie" dans le "Chemin de Long Estude" de Christine de Pizan

Alors qu’elle se trouve au Mont Parnasse, la narratrice du Chemin de Long Estude de Christine de Pizan affirme reconnaître l’endroit pour l’avoir déjà lu chez Dante. Cette mention surprend considérant la quasi absence de la Comédie dans la littérature française de la fin du Moyen Âge, et si la tradition critique a eu tendance à y voir la revendication d’un projet mimétique, où le poème de Christine de Pizan serait une tentative d’imitation de la Comédie, les nombreux échos dantesques de l’oeuvre témoignent à l’inverse d’un important travail d’appropriation, en mettant systématiquement l’accent sur l’acquisition du savoir et l’inscription dans une filiation intellectuelle. Plus qu’une recension, le présent mémoire aspire à faire le point sur les présences de la Comédie dans le Chemin de Long Estude de même qu’à inscrire ces dernières dans un réseau. Cela amène non seulement à considérer l’oeuvre de Christine de Pizan dans sa totalité, mais aussi en regard des considérations littéraires de l’époque. Dans le premier cas, les renvois à Dante permettent de réfléchir au projet général de l’oeuvre, alors que le poème italien, plus que de représenter un idéal à reproduire, participe à une conquête de l’ordre par le savoir, aux côtés de la Consolation de Philosophie de Boèce et du Chemin de Long Estude lui-même. Dans le second cas, le fait de fonder le travail d’écriture sur la lecture préalable d’un auteur italien témoigne de la bibliophilie du siècle et de l’importance de la lecture, mais aussi de l’émergence timide de nouvelles autorités vernaculaires.

A Periodic State Space Model to Monthly Long-term Temperature Data

This work presents a periodic state space model to model monthly temperature data. Additionally, some issues are discussed, as the parameter estimation or the Kalman filter recursions adapted to a periodic model. This framework is applied to monthly long-term temperature time series of Lisbon.

Adoecimento osteomuscular de trabalhadores portuários avulsos e o processamento do raciocínio clínico da enfermagem

Introdução: O trabalho portuário é composto por condicionantes socioambientais necessários à manutenção das funções operativas, mas que influenciam na produção de doenças osteomusculares. O conhecimento desses condicionantes instrumentaliza o raciocínio clínico da Enfermagem para o planejamento de ações em saúde. Desta forma, defende-se a tese de que “O conhecimento dos condicionantes socioambientais e pessoais do adoecimento osteomuscular do trabalhador portuário avulso fornece elementos ao processamento do raciocínio clínico da Enfermagem, para assistência em saúde do trabalhador”. Objetivos: identificar evidências científicas de adoecimento ocupacional do trabalhador portuário publicadas na literatura cientifica; caracterizar o tipo, a localização e a intensidade de sintomas osteomusculares relacionados com os condicionantes socioambientais do trabalho portuário; Relacionar as doenças osteomusculares autorreferidas por trabalhadores portuários e os condicionantes socioambientais deste trabalho. Percurso Metodológico: o estudo apresentou revisão sistemática, fundamentada no método Cochrane; e estudos descritivos e exploratórios de abordagem quantitativa, realizado por meio de entrevista semi-estruturada com 232 trabalhadores portuários avulsos. Os dados foram analisados no software Statistical Package for the Social Sciences (SPSS) 21.0, por frequência simples, proporções e testes inferenciais não-paramétricos. A tese integra o macro projeto de pesquisa “Saúde do Trabalhador, Riscos, Acidentes e Doenças Relacionadas ao Trabalho: Estudo com Trabalhadores em um Porto no Extremo Sul do Brasil”, aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Rio Grande (CEPAS-FURG) sob parecer número 118/2013. Resultados: Na revisão sistemática, selecionaram-se 16 publicações; todas as publicações pertenceram ao nível de evidência quatro, destacando o câncer pulmonar, doenças osteomusculares e isquêmicas, com nexo causal em riscos químicos oriundos da exaustão veicular e das cargas transportadas. Nos estudos descritivos, os sintomas prevalentes foram a dor leve em membros superiores (51,7%) e intensa a insuportável na coluna vertebral (19%). Os dois adoecimentos mais autorreferidos foram lombocitalgia (36,8%; n=50 – em terra e 28,1%; n=27 – a bordo) e tendinite (27,9% - em terra e 31,3% - a bordo). Discussão: O câncer pulmonar ocupacional foi causado por componentes químicos da exaustão veicular e do amianto transportado nas operações portuárias. Com relação à saúde muscular, a idade, o tempo e a jornada de trabalho mostraram-se condicionantes importantes na identificação de sintomas e adoecimentos, e o quanto estes fatores interveem na percepção da intensidade, contribuindo no autocuidado para prevenção e tratamento. Conclusão: O conhecimento dos condicionantes socioambientais relacionados ao trabalhador e caracterizados nos ambientes de trabalho deve ser atual e pregresso, o que somado à apreensão dos sintomas e adoecimentos autorreferidos pelos trabalhadores instrumentalizou o RC, identificando uma atuação profissional em longo prazo para dirimir os adoecimentos identificados. As características clínicas obtidas, em conjunto com a literatura, conduziram ao processamento do RC da enfermagem nesta realidade, sendo a informação em saúde um ponto chave para a promoção da saúde muscular dos trabalhadores.

Thermal activation, long-range ordering, and topological frustration of artificial spin ice

Frustrated systems, typically characterized by competing interactions that cannot all be simultaneously satisfied, are ubiquitous in nature and display many rich phenomena and novel physics. Artificial spin ices (ASIs), arrays of lithographically patterned Ising-like single-domain magnetic nanostructures, are highly tunable systems that have proven to be a novel method for studying the effects of frustration and associated properties. The strength and nature of the frustrated interactions between individual magnets are readily tuned by design and the exact microstate of the system can be determined by a variety of characterization techniques. Recently, thermal activation of ASI systems has been demonstrated, introducing the spontaneous reversal of individual magnets and allowing for new explorations of novel phase transitions and phenomena using these systems. In this work, we introduce a new, robust material with favorable magnetic properties for studying thermally active ASI and use it to investigate a variety of ASI geometries. We reproduce previously reported perfect ground-state ordering in the square geometry and present studies of the kagome lattice showing the highest yet degree of ordering observed in this fully frustrated system. We consider theoretical predictions of long-range order in ASI and use both our experimental studies and kinetic Monte Carlo simulations to evaluate these predictions. Next, we introduce controlled topological defects into our square ASI samples and observe a new, extended frustration effect of the system. When we introduce a dislocation into the lattice, we still see large domains of ground-state order, but, in every sample, a domain wall containing higher energy spin arrangements originates from the dislocation, resolving a discontinuity in the ground-state order parameter. Locally, the magnets are unfrustrated, but frustration of the lattice persists due to its topology. We demonstrate the first direct imaging of spin configurations resulting from topological frustration in any system and make predictions on how dislocations could affect properties in numerous materials systems.

The impact of indoor air quality and contaminants on respiratory health of older people living in long-term care residences in Porto

Background: persons who are 65 years or older often spend an important part of their lives indoors thus adverse indoor climate might influence their health status. Objective: to evaluate the influence of indoor air quality and contaminants on older people’s respiratory health. Design: cross-sectional study. Setting: 21 long-term care residences (LTC) in the city of Porto, Portugal. Subjects: older people living in LTC with ≥65 years old. Methods: the Portuguese version of BOLD questionnaire was administered by an interviewer to older residents able to participate (n = 143). Indoor air contaminants (IAC) were measured twice, during winter and summer in 135 areas. Mixed effects logistic regression models were used to study the association between the health questionnaire results and the monitored IAC, adjusted for age, smoking habits, gender and number of years living in the LTC. Results: cough (23%) and sputum (12%) were the major respiratory symptoms, and allergic rhinitis (18%) the main selfreported illness. Overall particulate matter up to 2.5 micrometres in size median concentration was above the reference levels both in winter and summer seasons. Peak values of particulate matter up to 10 micrometres in size (PM10), total volatile organic compounds, carbon dioxide, bacteria and fungi exceeded the reference levels. Older people exposed to PM10 above the reference levels demonstrated higher odds of allergic rhinitis (OR = 2.9, 95% CI: 1.1–7.2). Conclusion: high levels of PM10 were associated with 3-fold odds of allergic rhinitis. No association was found between indoor air chemical and biological contaminants and respiratory symptoms.

Carpal tunnel syndrome and computer exposure at work in two large complementary cohorts.

International audience

Exploring coordination-driven self-assembly with autonomous chemical robots

The work presented herein focused on the automation of coordination-driven self assembly, exploring methods that allow syntheses to be followed more closely while forming new ligands, as part of the fundamental study of the digitization of chemical synthesis and discovery. Whilst the control and understanding of the principle of pre-organization and self-sorting under non-equilibrium conditions remains a key goal, a clear gap has been identified in the absence of approaches that can permit fast screening and real-time observation of the reaction process under different conditions. A firm emphasis was thus placed on the realization of an autonomous chemical robot, which can not only monitor and manipulate coordination chemistry in real-time, but can also allow the exploration of a large chemical parameter space defined by the ligand building blocks and the metal to coordinate. The self-assembly of imine ligands with copper and nickel cations has been studied in a multi-step approach using a self-built flow system capable of automatically controlling the liquid-handling and collecting data in real-time using a benchtop MS and NMR spectrometer. This study led to the identification of a transient Cu(I) species in situ which allows for the formation of dimeric and trimeric carbonato bridged Cu(II) assemblies. Furthermore, new Ni(II) complexes and more remarkably also a new binuclear Cu(I) complex, which usually requires long and laborious inert conditions, could be isolated. The study was then expanded to the autonomous optimization of the ligand synthesis by enabling feedback control on the chemical system via benchtop NMR. The synthesis of new polydentate ligands has emerged as a result of the study aiming to enhance the complexity of the chemical system to accelerate the discovery of new complexes. This type of ligand consists of 1-pyridinyl-4-imino-1,2,3-triazole units, which can coordinate with different metal salts. The studies to test for the CuAAC synthesis via microwave lead to the discovery of four new Cu complexes, one of them being a coordination polymer obtained from a solvent dependent crystallization technique. With the goal of easier integration into an automated system, copper tubing has been exploited as the chemical reactor for the synthesis of this ligand, as it efficiently enhances the rate of the triazole formation and consequently promotes the formation of the full ligand in high yields within two hours. Lastly, the digitization of coordination-driven self-assembly has been realized for the first time using an in-house autonomous chemical robot, herein named the ‘Finder’. The chemical parameter space to explore was defined by the selection of six variables, which consist of the ligand precursors necessary to form complex ligands (aldehydes, alkineamines and azides), of the metal salt solutions and of other reaction parameters – duration, temperature and reagent volumes. The platform was assembled using rounded bottom flasks, flow syringe pumps, copper tubing, as an active reactor, and in-line analytics – a pH meter probe, a UV-vis flow cell and a benchtop MS. The control over the system was then obtained with an algorithm capable of autonomously focusing the experiments on the most reactive region (by avoiding areas of low interest) of the chemical parameter space to explore. This study led to interesting observations, such as metal exchange phenomena, and also to the autonomous discovery of self assembled structures in solution and solid state – such as 1-pyridinyl-4-imino-1,2,3-triazole based Fe complexes and two helicates based on the same ligand coordination motif.

Predicting long-term outcome after acute ischemic stroke: a simple index works in patients from controlled clinical trials

Background and Purpose—An early and reliable prognosis for recovery in stroke patients is important for initiation of individual treatment and for informing patients and relatives. We recently developed and validated models for predicting survival and functional independence within 3 months after acute stroke, based on age and the National Institutes of Health Stroke Scale score assessed within 6 hours after stroke. Herein we demonstrate the applicability of our models in an independent sample of patients from controlled clinical trials. Methods—The prognostic models were used to predict survival and functional recovery in 5419 patients from the Virtual International Stroke Trials Archive (VISTA). Furthermore, we tried to improve the accuracy by adapting intercepts and estimating new model parameters. Results—The original models were able to correctly classify 70.4% (survival) and 72.9% (functional recovery) of patients. Because the prediction was slightly pessimistic for patients in the controlled trials, adapting the intercept improved the accuracy to 74.8% (survival) and 74.0% (functional recovery). Novel estimation of parameters, however, yielded no relevant further improvement. Conclusions—For acute ischemic stroke patients included in controlled trials, our easy-to-apply prognostic models based on age and National Institutes of Health Stroke Scale score correctly predicted survival and functional recovery after 3 months. Furthermore, a simple adaptation helps to adjust for a different prognosis and is recommended if a large data set is available. (Stroke. 2008;39:000-000.)

Germinação e armazenamento de sementes de COCA (Erythroxylum ligustrinum DC. - Erythroxylaceae)

O objetivo deste trabalho foi avaliar o efeito da temperatura sobre a germinação e o armazenamento de sementes de Erythroxylum ligustrinum DC. As sementes foram colocadas germinar caixas de plásticas sobre duas folhas de papel, umedecidas com Nistatina 0, 2%, mantidas em germinadores nas temperaturas constantes de 5, 10, 15, 20, 25, 30, 35, 40 e 45ºC e com fotoperíodo de 12 horas. Para o armazenamento, as sementes foram colocadas em sacos de papel, mantidos à temperatura ambiente e em geladeira. em seguida, mensalmente, foi avaliada a germinação das sementes. A temperatura mínima, a faixa de temperatura ideal e a temperatura máxima para germinação de sementes de coca estão entre 10 e 15ºC, 25 e 30ºC e 40 e 45ºC, respectivamente. O armazenamento de sementes coca por longo período é inviável em embalagens de papel na geladeira (10ºC ± 2) e em temperatura ambiente (27ºC ± 5).

Accidents at work by excessive efforts / inappropriate movements in nurses

Nurses continuously develop various activities that expose them to excessive force and inappropriate movements. Characterize the accidents reported by overexertion and inappropriate movements in Portuguese nurses during 2009 and 2010. Retrospective cross-sectional study, covering the period from January 1, 2009 to December 31, 2010. Were defined as inclusion criteria, be nurse and having notified by excessive straining and improper motion accident. The information was obtained by reference to the computer record of accidents at work General Administration of Health Services, relating to 672 nurses. There were 672 notifications of accidents by overexertion/ inappropriate moves in Portuguese nurses. The higher prevalence of these accidents was in nurses with over 10 years of service 277 (41.2%), 565 were female (42.6%) in the age group 25-29 (29.9%) and practice time for 555 shifts (82.6%). At admission there were 387 (57.3%) within 3 hours of work 330 (49.1%) and the third day after weekly rest 216 (32.1%). The Mobilization of patients was the most frequent cause of this accident 430 (64.0%). The main effects were the sprains and strains 321 (47.8%), mainly the trunk reached 367 (54.7%) and absenteeism caused 373 (55.5%). On average 17.7 days missed a total of 12.054 days. There was a high prevalence of accidents during the mobilization of prayer on patients so importante to invest in the implementation of mechanical equipment for the mobilization and transport of patients.

Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations

Background Writing therapy to improve physical or mental health can take many forms. The most researched model of therapeutic writing (TW) is unfacilitated, individual expressive writing (written emotional disclosure). Facilitated writing activities are less widely researched. Data sources Databases including: MEDLINE, EMBASE, PsychINFO, Linguistics and Language Behavior Abstracts, AMED, and CINHAL were searched from inception to March 2013. Review methods Four TW practitioners provided expert advice. Study procedures were conducted by one reviewer and checked by a second. Randomised controlled trials (RCTs) and non-randomised comparative studies were included. Quality was appraised using the Cochrane risk of bias tool. Unfacilitated and facilitated TW studies were analysed separately under ICD-10 chapter headings. Meta-analyses were performed where possible using Revman 5.2. Costs were estimated from an NHS perspective and three cost-consequence case studies were prepared. Realist synthesis followed RAMESES guidelines. Objectives To review the clinical and cost-effectiveness of TW for people with long-term health conditions (LTCs) compared to no writing, or other controls, reporting any relevant clinical outcomes. To conduct a realist synthesis to understand how TW might work, and for whom. Results From 14,658 unique citations, 284 full text papers were reviewed and 64 studies (58 RCTs) were included in the final effectiveness reviews. Five studies examined facilitated TW, these were extremely heterogeneous with unclear or high risk of bias, but suggested that facilitated TW interventions may be beneficial in individual LTCs. Unfacilitated expressive writing was examined in 59 studies of variable, or unreported, quality. Overall there was very little or no evidence of any benefit reported in the following conditions (number of studies): HIV (six); breast cancer (eight); gynaecological and genitourinary cancers (five); mental health (five); asthma (four); psoriasis (three); chronic pain (four). In inflammatory arthropathies (six) there was a reduction in disease severity (n= 191, standardised mean difference (SMD) - 0.61 [95% confidence intervals (95% CI) -0.96, -0.26]) in the short term on meta-analysis of four studies. For all other LTCs there was either no, or sparse, data with no, or inconsistent, evidence of benefit. Meta-analyses conducted across all the LTCs provided no evidence that unfacilitated EW had any effect on depression at short term (n= 1,563, SMD -0.06, 95% CI -0.29 to 0.17, substantial heterogeneity), or long term (n= 778, SMD-0.04 95% CI -0.18 to 0.10, little heterogeneity) follow up, or on anxiety, physiological or biomarker-based outcomes. One study reported costs, none reported cost-effectiveness, twelve reported resource use; meta-analysis suggested reduced medication use but no impact on health centre visits. Estimated costs of intervention were low, but there was insufficient evidence to judge cost-effectiveness. Realist review findings suggested that facilitated TW is a complex intervention and group interaction contributes to the perception of benefit. It was unclear from the available data who might benefit most from facilitated TW. Limitations Difficulties with developing realist review programme theory meant that mechanisms operating during TW remain obscure. Conclusions Overall there is little evidence to support the effectiveness or cost-effectiveness of unfacilitated expressive writing interventions in people with LTCs. Further research focussed on facilitated TW in people with LTCs could be informative.

Some misspecfication problems in long-memory time series models

Doctor of Philosophy in Mathematics